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Full text of "The Physical Examination of Prisoners on Admission to Prison"

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NOTES AND ABSTRACTS 



Anthropology— Psychology— Legal Medicine 
The Physical Examination of Prisoners on Admission to Prison. — 
At this time, when prison problems are much in the public mind, and are being 
discussed in terms of mental efficiency or feeble mindedness; when Binet- 
Simon tests, point scale examinations, and intelligence quotients seem to be 
signs of modern prison progress, and the sine qua non of juvenile delinquent 
reformation, a consideration of the physical fitness of the adult delinquent 
may seem like a reversion to the archaic. But a normal mind requires a healthy 
body to attain its highest efficiency. How necessary, then, in studying the 
individual delinquent, that we should endeavor to obtain the physical health 
survey as well as the intelligence quotient. 

While many investigators of prison problems have been dazzled by the 
opening up of a bright vista, in our recently acquired knowledge of methods 
for sorting out the feeble-minded, the prison physician cannot lose sight of 
the other, the physical side of the problem, which offers considerable incentive 
from the fact that, while feeble-mindedness cannot be cured, physical health 
may be restored. 

Object. The object of our examinations at Auburn, aside from the out- 
lining of individual treatment, has been twofold. 

1st To determine, as accurately as possible for statistical purposes, the 
actual physical condition of the convicted men at the time of their admission 
to prison. 

2nd. To obtain an idea of the amount of the medical and surgical treat- 
ment that would be required to restore these men to the most efficient healthful 
conditions. 

Scope. It is not a complete medical survey of the prison population, but 
is limited to those admitted during one single year, and does not include those 
who are already present. Nor does it represent the total amount of medical 
and surgical ' work that is required of the medical staff, since it does not 
comprise the illnesses, injuries, or pathological conditions that arise after these 
men have been admitted. Indeed, it would be almost impossible to make a 
complete medical and surgical survey of a population that is constantly fluctu- 
ating, as at this institution, where the number arriving during the year exceeded 
one thousand, and the number departing approximated nearly that figure. 

Basis. The basis of this compilation is the records obtained in the routine 
entrance physical examinations of all inmates admitted to Auburn Prison during 
the fiscal year of October 1, 1914, to September 30, 1915. This includes not 
only the men admitted directly from the courts, but also those transferred from 
other prisons and reformatories as well as those returned for violation of 
parole or previous escape. During the year there were 1,025 admissions, as 
follows : 

From State Courts 364 36 per cent. 

From Sing Sing Prison 593 58 per cent. 

From Clinton Prison 33 3.5 per cent. 

From violation of parole 30 3 per cent. 

From escape 2 

From Elmira Reformatory. 1 

From Dannemora State Hospital 1 

From Great Meadow Prison 1 

Total ...1,025 



PHYSICAL EXAMINATION 447 

Time of examinations. These examinations are made within a day or two 
after admission, often on the same day, though on the occasion of a large 
draft from another prison, which may consist of as many as fifty or sixty men, 
a week or ten days may elapse before the completion of the examinations. 

Method. The routine examination is comprehensive and as complete as the 
usual insurance examination given at a physician's office. The outline of the 
examination is as follows: 

1. General inspection. 9. Nervous system. 

2. Stigmata of degeneracy. A. General. 

3. Alimentary system. B. Special senses. 

4. Respiratory system. 1. Eyes. 

5. Circulatory system. 2. Ears. 

6. Genitourinary system. 10. Articular and muscular. 

7. Cutaneous system. 11. Deformities. 

8. Glandular system. 

The patient is stripped, first to the waist, then later completely, so that direct 
inspection and examination may be made of the whole body. Uranalysis, 
hemoglobin estimations, examination of blood and pus stains, blood counts, and 
other tests that can be rapidly performed are made at once, as indicated, to 
complete the initial examination. Simple interrogation alone is never depended 
upon for any part of the examination, but is accompanied by inspection and 
other forms of inquiry as may seem necessary, to determine any pathological 
condition. Of course, no assertion is made of absolute accuracy of diagnoses, 
since many of those admitted require further observation to determine their 
exact condition, so that the tabulations represent the conditions presented to 
the examiner on the first examination. This series of examinations has been 
made by one and the same examiner. 

Place. The routine examinations have all been made in the privacy of the 
physician's office, no one else being present except the physician's clerical or 
laboratory assistant. 

Examiner. The examiner is the prison physician who has been making 
similar examinations for nearly ten years. 

Character of subjects. Those examined are all male adults, ranging in age 
from eighteen to over eighty years, sentenced for a wide variety of crimes; 
comprising all classes, from the accidental first term criminal to the recidivist 
of deliberate choice; representing nearly all occupations, races, and religions, 
and grading mentally from the medium grade imbecile to those capable of 
conducting a business or practicing a profession. 

Method of classification. As a result of the examinations, the subjects have 
been graded into three groups, according to the state of health, good, fair, or 
poor. Such classifications are not made from the medical standpoint purely, 
but represent working ability as related to the institution, but not necessarily 
corresponding to their previous mode of living or occupation before admission 
to prison. Such classification is admittedly arbitrary, but useful as well as 
necessary. 

Total number admitted 1,025 

Those in good health 800 78 per cent. 

Those in fair health 147 14 per cent. 

Those in poor health 70 8 per cent 

1,017 
Not examined because of early transfer to 

another institution 8 



448 CAUSE OF INSANITY 



SUMMARY OF DEFECTS FOUND 

Good. Fair. Poor. Total. 

Alimentary system 1,022 222 130 1,374 

Respiratory system 942 235 122 1,299 

Circulatory system 98 83 43 224 

Genitourinary system 63 38 24 125 

Cutaneous system 92 17 23 132 

Glandular system 571 116 55 742 

Nervous system : 

General 54 19 18 91 

Eyes 332 83 29 444 

Ears 108 18 11 137 

Articular and muscular 194 50 21 265 

Deformities 36 10 12 58 

Total 3,512 891 488 4,891 

Summary of Number of Operations Needed. 

Alimentary system 148 

Respiratory system 416 

Genitourinary system 45 

Cutaneous system 7 

Glandular system 50 

Nervous system — general 3 

Nervous system — special senses, eyes 37 

Nervous system — special senses, ears 25 

Articular and muscular systems 2 

Deformities 1 

Total 734 

The foregoing lists, it will be observed, do not include dental work, of 
which there is a vast amount indicated, as over half of the total number of men 
admitted had carious teeth ; nor do they include refraction and fitting of glasses 
for at least 200 prisoners. 

CONCLUSIONS. 

1. The solution of the medical problem of the prison lies, to a great extent, 
in the recognition and treatment of pathological conditions at the time of ad- 
mission of each inmate. 

2. The medical staff of the prison, consisting of only two physicians, is 
much too small to take care of this immense amount of work. As a matter of 
fact, a staff of two is inadequate to perform a major operation. 

3. There should be provided an adequate general medical and surgical 
staff, as well as specialists in the various branches. 

4. This work could best be accomplished through -a central clearing house 
to which all prisoners should first be committed for individual examination, 
study, diagnosis, and treatment, before being assigned to any particular insti- 
tution. — Abstracted from article by Dr. Frank L. Heacox of Auburn Prison in 
New York Medical Journal, Jan. 13, 1917. Copyrighted by the A. R. Elliott 
Pub. Co. 

Syphilis a Factor In Cause of Insanity. — Although the state of Cal- 
ifornia cared for 10,331 insane patients during 1916, providing them with the 
very best of care, there is almost nothing done in the prevention of insanity. 
The insane in California receive the best of care. This is certainly as it should 
be, for these unfortunates are entitled to the very best of treatment. While